Biomedical subjects

Lori A Shutter

Publications and source records attributed to Lori A Shutter.

6 recordsLinked to original sources

PubMed2004

Diffuse axonal injury in children: clinical correlation with hemorrhagic lesions.

An inception cohort of 40 children and adolescents with traumatic brain injury and suspected diffuse axonal injury were studied using a new high-resolution magnetic resonance imaging susceptibility-weighted technique that is very sensitive for hemorrhage. A blinded comparison was performed between the extent of parenchymal hemorrhage and initial clinical variables as well as outcomes measured at 6 to 12 months after injury. Children with lower Glasgow Coma Scale scores (< or =8, n = 30) or prolonged coma (>4 days, n = 20) had a greater average number (p = 0.007) and volume (p = 0.008) of hemorrhagic lesions. Children with normal outcomes or mild disability (n = 30) at 6 to 12 months had, on average, fewer hemorrhagic lesions (p = 0.003) and lower volume (p = 0.003) of lesions than those who were moderately or severely disabled or in a vegetative state. Significant differences also were observed when comparing regional injury to clinical variables. Because susceptibility-weighted imaging is much more sensitive than conventional T2*-weighted gradient-echo sequences in detecting hemorrhagic diffuse axonal injury, more accurate and objective assessment of injury can be obtained early after insult, and may provide better prognostic information regarding duration of coma as well as long-term outcome.

Adolescent↗

PubMed2003

Hemorrhagic shearing lesions in children and adolescents with posttraumatic diffuse axonal injury: improved detection and initial results.

PURPOSE: To compare the effectiveness of a high-spatial-resolution susceptibility-weighted (SW) magnetic resonance (MR) imaging technique with that of a conventional gradient-recalled-echo (GRE) MR imaging technique for detection of hemorrhage in children and adolescents with diffuse axonal injury (DAI). MATERIALS AND METHODS: Seven young patients with a mean Glasgow Coma Scale score of 7 +/- 4 (SD) at admission were imaged a mean of 5 days +/- 3 after injury. High-spatial-resolution three-dimensional GRE imaging performed with postprocessing by using a normalized phase mask was compared with conventional GRE MR imaging. The total and mean values of lesion number and apparent hemorrhage volume load determined with both examinations were compared. Mean values were compared by using paired t test analysis. Differences were considered to be significant at P < or =.05. RESULTS: Hemorrhagic lesions were much more visible on SW MR images than on conventional GRE MR images. SW MR imaging depicted 1,038 hemorrhagic DAI lesions with an apparent total hemorrhage volume of 57,946 mm3. GRE MR imaging depicted 162 lesions with an apparent total hemorrhage volume of 28,893 mm3. SW MR imaging depicted a significantly higher mean number of lesions in all patients than did GRE MR imaging, according to results of visual (P =.004) and computer (P =.004) counting analyses. The mean hemorrhage volume load for all patients also was significantly greater (P =.014) by using SW MR imaging according to computer analysis. SW MR imaging appeared to depict much smaller hemorrhagic lesions than GRE MR imaging. The majority (59%) of individual hemorrhagic DAI lesions seen on SW MR images were small in area (<10 mm(2)), whereas the majority (43%) of lesions seen on GRE images were larger in area (10-20 mm(2)). CONCLUSION: SW MR imaging depicts significantly more small hemorrhagic lesions than does conventional GRE MR imaging and therefore has the potential to improve diagnosis of DAI.

Adolescent↗

PubMed2002

Mental status and behavioral changes in the early postacute phase of care.

Neurocognitive sequelae of stroke create a significant impact on the patient and frequently disrupt recovery from the physical manifestations. This article strives to review types of neurocognitive changes after stroke and discuss the underlying pathophysiology. Management options are presented for the diverse changes that may be encountered.

Journal Article↗

PubMed2002

Modern stroke unit.

The modern stroke unit is making significant contributions to the care of stroke victims and is proving to be an effective, cost-saving enterprise. The precise factors that contribute to the efficacy of these units have yet to be identified, but a combination of protocolized approaches to patient care, critical paths, a focus of expertise, and heightened index of suspicion for comorbidities all probably play a role. This article outlines the basic features of a modern stroke unit and surveys the literature on stroke unit outcomes.

Journal Article↗

PubMed2002

Influence of specific stroke diagnosis on prognostication, recovery, and early management.

Strokes are focal lesions in the brain and as such bring about deficits and portend a course of recovery depending on the nature of the lesion. Given the large number of possible combinations of locations, sizes, and types of lesions, a clear and reliable formula for predicting outcomes based on these characteristics has been statistically difficult, particularly early in the course of recovery. Severity of deficit and age of the patient accounts for sufficient variability that the influence of other factors becomes statistically harder to illustrate.

Journal Article↗

PubMed2002

Rehabilitation interventions during acute care of stroke patients.

The immediate care of a stroke patient admitted to hospital is best provided in a dedicated stroke unit, within which all of the key components of care can be coordinated. Neurologic diagnosis and intervention and general medical care are essential elements of acute stroke management. However, optimal outcome requires a comprehensive and multidisciplinary approach, which includes rehabilitation interventions. During the initial phases of care, rehabilitation interventions are mostly passive and emphasize prevention of secondary co-impairments such as contractures, pressure ulcers, and deconditioning. Rehabilitation interventions should be incorporated into care protocols for all patients and should begin immediately. As the patient becomes stable, more intensive therapy can be initiated in preparation for transition into the postacute phase of active rehabilitation.

Journal Article↗